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BUILDING- INSPECTOR RECORD SITE.WORK DAT.E .lD/slG.COMMENTS Set Backs a Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bf !oor/Ve nt/l n s u I atio n Roof Sheathing Shear Wall Framing R18Z,l 0.<*24 lnsulation/Energy A Drywall v(gat l?-dz rl Ext./lnt. Lath Brown Coat lVlasonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif . /' FINAL 7-294 /L hrn ',â‚¬46 ?zv Certificate of Occupancy Notes, Remarks, Etc. OWNER BUILDER DELCARATION I hcreby affirm undcr pcnahy of pcrjury that I am cxcmpt frcm thc Contractors' Liccnsc Law for thc following rcasn (Src.?031.5. . Busincss and Profcssion Codc): Any City or County which rcquircs a pcrmit to construcl, altcl improve, dcmlish or rcpair any structuc. prk r to its issuarcc, alm rcquircs the opplicont for such pcrmit to tih a signed statcrcnt that he or shc is liccosd pusuolt to lhc pmvisions of thc Contractor's Liccnrcd law (Chapter 9, Commcncing wilh Setion 70fi) of Division 3 of the Business md ProlbssioosCodc)orthathcorshciscxcmptthercfromandthebasisforlhcallegcdexemption. Anyviolationofs6tion?O3l.5byotry applicant for a pcrmit subjects thc applicant to a civil pcmlty of not mrc than fivc hundrcd dollars ($500). _1. as owncr of thc propcrty, or my cmployccs with wages as thcir sole compcnsation, will do thc work and thc structurc is not intcndcd or ofl'crcd firr salc (Sec.7M4, Busincss and Prolbssions Codc: Thc Contractor's License Law docs not apply to an owner of thc propcrty who builds or improvcs thcrctrr, and who docs such work himsclf or hcrsclf or through his or her own employees, providcd that such irnprovenrcnts are not intended or offered for salc. If, howcver. the building or improvenrcnt is sold within onc ycar of cornplction. thc Owner Builder will havc the burden of proving that hc or she did not build or improvc thc property for thc purposc of sale). -1. as owner of thc propcrt), am cxclusivcly contracting with liccnscd contraclors to construct thc projcct (Scc. 7M4, Busincss and Profcssion Code: Thc Contraclor's Liccnse Law docs not apply to arl owner of property who builds or improves thereon, and who contracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's Licensc Law). _l arn excmpt undcr Scction_. B. & P.C. fbr this rcason. I)ate: WABTEESSOMSENTAIIAN DECIABAIION I hcrcby affirm undcr pcnalty ofpcrjury onc ofthe following declmtions: SfAmvcarawitlmintainaCertificatcofconsnttoself-lnsurcforworkqs'ompcnsolion,as prcvidcdforbySetion3?0Oofthc tabor Codq for thc Frformncc of thc work for which the lEmit is issued, Jlftave and will minlain workcn' comlrcnsation insurancc, as rcquircd by Scclion 3700 of thc Labor Codc. for thc pcrforrc of thc work for which this pcrmit is issucd. My workss' compensation insumce cmier atrd policy number re: .-*,^.. <1 n4. Fr )rt nJ lL-LCtPolicy -l ccrtity that in the perf<rrrnancc of thc work for which this pcrmit is issucd. I shall not enrploy any pcrson in any nranncr so as lo bccomc subjcct to the workcrs' compensation laws of California. and agrcc that if I should bccomc subject to thc workcrs' conrpensation provisions of Section 3700 of thc Labor Code, I shall, forthwith cornply with those provisions. WARNING: Failurc lo secure workers' contpensation covcrage is unlawful, and shall subject an crnployer to criminal pcnaltics and civil fines up to onc hundrcd thousand dollars ($100.0m). in addition to thc cost of compensation, damagcs as provided fbr the Scction 3076 of the Labor Code, intcrcst and attorncy's fccs. o "^,", 07 /0 6f I (Annricanr: 5or&c A - kA rrl ) 0 LICENSBIT(IN'Tf,.AC'I'(}R I DECLARATION I hercby affirrn undcr pcnalty of pcrjury that I am liccnscd undcr provision of Chaptcr 9 (cornmencing with Scction 7000) of Division 3 of the Busincss and Professions Codc. and rny liccnsc is in full force and cffcct. Liccnse Date: Nunrbcr: / 06 / 1 t I I W I hercby affirrn undcr pcnahy of pcrjury thlt thcrc is a onstruction lcnding agcrcy for thc pcrformns of thc work for which this lrcrmit is issued (Sec. 3097, Civ. C.). hndcr's Namc: Lcndcr's Acldrcss: APPLICANT DECLARATION I hercby affinn undcr pcnalty of pcrjury onc o[ thc tbllowing declarations: Dcrnolition Permits-Asbestos Notification Fcderal Rcgulations (Title 40. Part6) _Required Lettcr of Notification _l cc(ify thdt thc fcdersl regulations regsding $bcstos rcmval drc not applicablc to this prcjcct, f(l ccnify tnat I havc read this application and stotc thut thc abovc infbrmrion is corcct. I agre to comply with ull Cityand County ordinances and Statc Laws rclating to building construction, ed hcrcby authoria rcprcsntativcs ofahis Cily and County to cntq ulren thc abovc rrtcrttioncd propcrty for purposcs. Applicanl or Agent Pernritee nilnre o^,,,07f 06/,t { t